I. Fellowship Council Accredited Fellowships in Surgery

A. Background

The unprecedented growth of knowledge and technology in surgical disciplines in the past 50 years, particularly the past two decades, has had a profound effect on the training of surgeons. The increased complexity of the diagnosis and management of many conditions has led to the evolution of post-residency, non-ACGME accredited fellowships in some areas of general surgery. For example, it is now considered desirable for a surgeon entering the practice of surgical oncology or organ transplantation in a major tertiary care center to have received additional specialty training after a general surgery residency. Leading professional organizations, such as the Society for Surgical Oncology (SSO) and the American Society of Transplant Surgeons (ASTS), have created fellowships—without seeking approval from the ACGME—to fill the need for training in fields not traditionally recognized as specialties.

Most surgeons recognize that there are specialists in certain surgical fields. Recent developments in these fields have included complex enabling technology that requires mastery of new cognitive, perceptual, and manual skills, further intensifying the need for formal post-residency training for surgeons who wish to make these areas the main focus of their careers. Before 2001, except for those few fellowships whose quality and organization were overseen by a particular specialty society (e.g., surgical oncology and transplantation fellowships), there were no organized, uniform, carefully monitored fellowship training programs in other areas where ad hoc fellowships had evolved (e.g., endoscopic, minimally invasive, gastrointestinal and hepato-pancreato-biliary surgery). There has been a growing demand for additional training from surgeons completing general surgery residency programs. Senior residents interested in such fellowships had to choose from a variety of locally organized programs, ungoverned by national quality standards. Although web sites of surgical societies provided descriptions of these opportunities, the information was often incomplete.

To address the needs of general surgery residents pursuing such postgraduate training, the Minimally Invasive Surgery Fellowship Council (MISFC) was established in 2001. Initially an informal organization of a small number of MIS fellowship program directors, it evolved into a legal entity and by 2003 had over 60 member fellowship programs and conducted a matching process where over 90 applicants matched into these programs. Coincident with the activities of the MISFC, three pre-eminent societies (the Society of American Gastrointestinal and Endoscopic Surgeons [SAGES], the Society for Surgery of the Alimentary Tract [SSAT], and the American Hepato-Pancreato-Biliary Association [AHPBA]) commissioned a joint committee to establish guidelines for fellowships in Endoscopic, Gastrointestinal and Hepato-Pancreato-Biliary surgery. The bylaws and organizational structure of the MISFC along with the guidelines document developed by this joint effort served as the basis for the evolution of the MISFC into The Fellowship Council (FC). Soon after the establishment of the FC, the American Society of Metabolic and Bariatric Surgery (ASMBS) joined the other members of the Council. In 2010, the American Society of Colon and Rectal Surgeons (ASCRS) also joined the Fellowship Council. By incorporating the leadership and organization of the MISFC and the guidelines established by the member societies, the Fellowship Council seeks to not only conduct practical activities around the process of managing a matching process and directory of fellowship programs, but also accredit programs to the standards outlined in this guidelines document.

The founding societies directed that the guiding principle for establishment of a fellowship in surgery be that such a fellowship must in no way interfere with or detract from the training of residents in general surgery and/or any other ACGME approved/ABMS- or Royal College of Physicians & Surgeons of Canada -recognized surgical training program. In several surgical subspecialties other than those represented here, the development of fellowships, certificates of special competence, and subspecialty board examinations have served to potentially limit general surgeons’ ability to practice all components of their general surgery training. To help avoid the development of such franchises in surgical practice, the Fellowship Council will not seek an ACGME-approved certificate of special competence or establish a certifying examination. Instead, the Fellowship Council program is based on the assumption that program applicants are fully trained in general surgery who seek exposure to an environment that will provide experience in surgical management of complex surgical problems including mastery of specialized surgical skills. This fellowship training is not being established to exclude other surgeons in the community from performing such procedures but to enhance the skills of those choosing this additional experience.

B. Objectives

We propose that the guidelines herein detailed will:

Provide a mechanism for establishing and accrediting fellowships in surgery.

Provide a mechanism to ensure that Fellowship Council accredited surgery fellowship programs attain and maintain a high level of quality.

Provide mechanisms to ensure that surgery fellowships do not interfere with residency training in general surgery and/or any other ACGME approved/ABMS- or Royal College of Physicians & Surgeons of Canada- recognized surgical training program.

Provide a central directory of approved surgery fellowships to which prospective fellows can apply.

Provide a central directory of data on approved surgery fellowships to assist general surgery residents in choosing the best fellowship for themselves.

Provide a diverse range of fellowship opportunities within the scope of general surgery.

Provide a mechanism for a matching process in the various fellowships governed by the FC.

II. PROGRAM REQUIREMENTS FOR FELLOWSHIPS IN SURGERY

A. General Information

In this document, a Fellowship Council fellowship (referred to as the “fellowship”) is defined as a clinical experience of not less than one year. Fellowship programs may be flexible in design but are required to provide a clear focus on the anatomical and functional evaluation of the diseases typically managed within the field of focus for the fellowship (e.g., GI Surgery, Bariatric Surgery, etc) as well as techniques for operative and postoperative management. In addition, it is essential that scholarly activity be integrated into the daily activities of the fellowship program. A research component of the fellowship may be included, especially in multi-year programs.

Fellowship training requires adequate previous training in general surgery. Thus, fellowships will follow completion of an accredited general surgery residency program in the United States or equivalent general surgery training outside the United States.

Rotations to other institutions for a period not exceeding 25% of the total time in the fellowship program may be approved; adequate educational justification for such rotations must be provided during program review.

Fellowship programs will not be approved if they will have a substantial negative effect on the training of general surgery residents and/or residents in any other ACGME approved/ABMS or Royal College of Physicians & Surgeons of Canada- recognized surgical training program. Specifically, the general surgery residency-training program cannot have been cited for a deficiency in the area of the proposed fellowship.

B. Program Director, Teaching Staff, and Support Personnel

Fellowships will be approved only in institutions capable of providing a scholarly environment for acquiring the necessary cognitive and procedural clinical and research skills essential to the surgical practice of trainees. This objective can be achieved only when the program director, the program’s faculty and staff, and the institution’s administration are fully committed to the educational program being offered. It is also imperative that appropriate resources and facilities be present. Service obligations must not compromise the fellowship’s educational goals and objectives.

1. Program Director

A single program director must be responsible for the fellowship program.

a. Qualifications of the program director

The program director must be a surgeon who is qualified to supervise and to educate fellows in the broad field of the fellowships focus as defined previously and must meet requirements similar to those required of program directors of ACGME-approved general surgery training programs. The director must be recognized nationally or regionally by his or her peers as a leader in some facet of the area of the program’s focus. Specifically, the program director must:

Be certified by the American Board of Surgery (ABS) or have equivalent qualifications.

Have an appointment in good standing to the medical staff of the institution sponsoring the fellowship program.

Be licensed to practice medicine in the state in which the sponsoring institution is located.

Maintain a cooperative working relationship with the director of the general surgery residency program (where one exists) and/or all other ACGME approved/ABMS- or Royal College of Physicians & Surgeons of Canada- recognized surgical training programs

Be a member in good standing of at least one of the constituent societies

Must have a minimum of two years experience, post training.

Must have published in a peer reviewed journal or presented at a national or regional meeting.

Demonstrated experience and/or expertise in teaching residents, fellows, or post graduate surgeons on a regional, national or international level.

b. Responsibilities of the program director

It is the responsibility of the program director to support the fellowship program by devoting his or her efforts to its management and administration. The director is also expected to be an active and recognized participant in the institution’s clinical and educational programs. This general responsibility includes the following specific activities:

Preparation of a written statement: to include an outline of the goals of the fellowship program with respect to knowledge, skills, and other attributes, a narrative description of the fellowship, including details of fellows’ involvement in clinical, research, teaching, and administrative activities, and a description of the relationship between the fellowship and the general surgery residency program. This statement must be made available to fellows, general surgery residents, the director of the general surgery residency program, and members of the teaching staff.

Selection of fellows for the program in accordance with institutional and departmental policies and procedures.

Selection and supervision of the teaching staff and other program personnel at each institution participating in the program.

Supervision of fellows through explicit written descriptions of supervisory lines of responsibility for the care of patients. Such guidelines must be communicated to all members of the fellowship program staff and to the general surgery staff and residents. Fellows must be provided with prompt, reliable systems for communicating and interacting with supervising physicians.

Organization and supervision of the research activities of fellows.

Organization and supervision of fellows’ participation in conferences and other educational activities, and oversight of implementation of the fellowship curriculum.

Organization and supervision of fellows’ interaction with general surgery residents at the educational, research, administrative, and patient care levels.

Implementation of fair procedures, as established by the sponsoring institution, regarding academic discipline complaints and grievances.

Monitoring of fellows’ stress level, including monitoring for mental and emotional conditions inhibiting job performance and for drug‑ or alcohol‑related dysfunction. The program director and teaching staff should be sensitive to the need, where applicable, for timely provision of confidential counseling and psychological support services to fellows. Training situations that consistently produce undesirable stress on fellows must be evaluated and modified.

Oversight of accurate tabulation and recording of operative logs by surgical fellows in the Fellowship Council case log system.

Notification in writing to the Membership and Accreditation Committees if there is change in Program Director and/or a significant change in the faculty complement for the fellowship. Programs must submit a formal letter to the Fellowship Council office.

2. Teaching staff

Other than the program director, additional teaching staff with documented qualifications and a commitment to instruct and supervise fellows must be available. Staff members should have a recognized record of achievement in clinical practice, teaching, research, or a combination of these. Faculty members should be primarily committed to the program’s area of focus and have a clinical practice that supports areas of special emphasis. Members of the teaching staff must be able to devote sufficient time to supervisory and teaching responsibilities.

When the fellowship program is located in more than one institution, a member of the teaching staff of each participating institution must be designated to assume responsibility for the day‑to‑day activities of the program at that institution, with overall coordination by the program director.

The teaching staff and program director must regularly and formally review each other’s performance in accordance with the goals and objectives of the fellowship.

The teaching staff should regularly evaluate the financial and clinical contribution of the resources available to the fellowship program, the contribution of each institution participating in the program, and the effect of the fellowship on the general surgery residency program.

3. Support Personnel

The fellowship program must be provided with the professional, technical, and clerical personnel needed for it to function smoothly and effectively.

C. Educational Principles

The principles of education enumerated in the Program Requirements for Residency Education in General Surgery published by the ACGME are also applicable to the fellowship. In particular:

The program director is responsible for ensuring that adequate facilities and resources are available to achieve the educational objectives.

The fellowship must provide advanced education such that fellows can acquire the special skills and knowledge of the field represented by the fellowship. This education should consist of both a cognitive and a technical component. The cognitive component should emphasize the scholarly attributes of self‑instruction, teaching, skilled clinical analysis, sound surgical judgment, and research creativity. The technical component must provide appropriate opportunity for fellows to acquire the operative skills required for the practice of advanced surgery.

The program director must establish an environment that is optimal for both the education of fellows and patient care, including the responsibility for continuity of care, while ensuring that fellows can avoid undue stress and fatigue. It is the program director’s responsibility to ensure assignment of appropriate in‑hospital duty hours so that fellows do not have prolonged working hours.

During in house on-call hours, fellows should be provided with adequate sleeping, lounge, and food facilities. There must be adequate backup so that patient care is not jeopardized during or after assigned periods of duty. Support services and systems must be such that fellows do not spend any significant amount of time in non-educational activities that can be conducted properly by other personnel.

D. Educational Components

1. General competencies

Fellows must become competent in the following six areas at the level expected of a surgery practitioner. Training programs must define the specific knowledge, skills, and attitudes required and provide the educational experience for fellows to demonstrate:

a. Patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.

f. Systems-based practice as manifested by actions that demonstrate an awareness of and response to the larger context and system of health care and effectively call on system resources to provide optimal care.

Specifically, fellows are expected to: 1) Practice high-quality, cost-effective patient care. 2) Demonstrate knowledge of risk-benefit analysis. 3) Demonstrate an understanding of the role of different specialists and other health care professionals in overall patient management.

2. Specific competencies

A sufficient number of patients must be available to ensure that fellows receive appropriate experience in the management of complex problems without adversely affecting the experience of residents in the general surgery core program. Specifically, a fellowship will not be approved in an institution that has a program deficiency in the pertinent areas of general surgery. Fellows must have adequate responsibility for continuity of care, including pre-hospital and post‑hospital experience, and these experiences must be distinct from those of General Surgery Chief residents if applicable.

Conferences, including medical‑surgical reviews, analyses of complications and deaths, seminars, and clinical and basic science instruction, must be regularly scheduled. In most cases, these educational activities will be shared with general surgery residents. Active participation of fellows in the planning and production of these meetings is essential to the fellows’ education and should enhance the education of general surgery residents.

Fellows must have the opportunity to provide patient consultation with faculty supervision. They should have clearly defined educational responsibilities for other residents, medical students, and professional personnel. These teaching experiences should involve correlation of basic biomedical knowledge with the clinical aspects of the fellowship.

A fellow may be appointed as an instructor to fulfill the role of a junior faculty member or as a postgraduate trainee, depending on the number of years of postgraduate training completed and institutional requirements and policies.

There must be close interaction between the fellowship program and the general surgery residency program and/or all other ACGME approved/ABMS- or Royal College of Physicians & Surgeons of Canada- recognized surgical training programs (where such programs exist). Lines of responsibility for general surgery residents and other residents and fellows must be defined clearly. Fellows may serve as teaching assistants for residents when appropriate.

The fellowship should include meaningful participation in the administrative activities of the department. Active learning about practice management and other administrative aspects related to the future practice of their specialty, surgical research, and surgical education of residents and medical students should be made available to fellows, as applicable. Fellowship programs are encouraged to include fellows in the departmental education committee that oversees the general surgery residency-training program, where applicable.

Adequate and appropriate supervision of fellows must be provided at all times, in accordance with each fellow’s level of experience and expertise and institutional rules and policies.

E. Research and Scholarly Activity

Graduate medical education must take place in an environment of inquiry and scholarship in which trainees participate in the development of new knowledge, learn to evaluate research findings, and develop habits of inquiry as a continuing professional responsibility. The responsibility for establishing and maintaining an environment of inquiry and scholarship rests with the program director and the teaching staff of the fellowship. Therefore, the staff as a whole must demonstrate broad involvement in scholarly activity. This activity should include at least some of the following:

Active participation of the teaching staff in regular clinical rounds, and conferences in a manner that promotes inquiry and scholarship. Scholarship implies an in‑depth understanding of basic mechanisms of normal and abnormal conditions and the application of current knowledge, techniques and technology to clinical practice.

A leadership role in journal clubs and research rounds/conferences with an emphasis on the fellowship’s area of focus.

Active participation in regional and national professional and scientific societies, particularly through presentations at the organizations’ meetings and publication in their journals.

Active participation in basic science and/or clinical investigations, particularly in projects with peer reviewed funding and those that result in presentation and publication at regional and national scientific meetings.

Provision of guidance and technical support as needed (for example, research design and statistical analysis) to students, residents, and fellows involved in research and other scholarly activities.

Provision of the opportunity for fellows to become involved in scientific or clinical investigations so that they may become familiar with the design, implementation, and interpretation of research studies.

Maintaining a thorough knowledge of current and evolving surgical techniques and technologies relative to the area of the fellowship.

Active supervision of the fellow in the OR, on the wards and in the clinics.

F. Library Facilities

Fellows must have ready access to a major medical library, either at the institution where they are located, through arrangement with nearby institutions, or by means of appropriate computer access to web portals.

The library services available to fellows should include electronic retrieval of information from medical databases.

G. Selection Process

Fellows should be selected in a fair and nondiscriminatory manner in accordance with the Equal Opportunities Act. The selection process may vary according to institution. Each program must make the details of the process known to applicants. During the selection process, applicants should be made familiar with the faculty’s experience, ongoing research, publications, and potential conflicts of interest (as defined by ACGME standards). It is essential that applicants have the opportunity to meet and question current fellows in the absence of the program director, faculty, and staff. If requested, a list of previous fellows with their current positions and contact information should be made available to applicants. Ultimately, selection of a fellow by an institution (and vice versa) will be done with use of a computerized matching process with logic identical to that of the National Resident Matching Program used by the Association of American Medical Colleges. The Communications Committee will oversee this matching process.

H. Completion of the Fellowship

At completion of the fellowship, fellows will be required to review with the program director their complete Fellowship Council case log; lists describing their research experience, grants, and publications; and curriculum vitae. These documents should be collected in a completion file for each fellow. The institution should maintain documentation on each fellowship for 10 years after its completion. On successful completion of fellowship, fellows should receive a certificate signed by the program director and department chair, where applicable, with the Fellowship Council seal affixed to the certificate.

In 2008 the Fellowship Council mandated that all Fellowship Council fellows should be FLS certified upon completion of the fellowship.

I. Evaluation of Fellows, Program Director, Teaching Staff, and Program

Fellows There must be regular evaluation of the fellows’ knowledge, skills, and overall performance, including the development of professional attitudes consistent with being a physician. Evaluation should be provided in a timely and constructive manner and be used primarily as a stimulus for improvement. To that end, the program director, with the participation of the teaching staff, general surgery residents, and students (if applicable) will:

Evaluate the knowledge, skills, and professional growth of fellows, using appropriate criteria and procedures, at least quarterly.

Communicate each evaluation to fellows in a timely manner

Advance fellows to positions of higher responsibility only on the basis of evidence of satisfactory progressive scholarship and professional growth. Maintain a permanent record of evaluation for each fellow that is accessible to the fellow and other individuals authorized by the fellow or fellowship program director.

A written final evaluation is required for all fellows who have completed a fellowship program. The evaluation must include a review of the fellow’s performance during the final period of training and should verify that the fellow has demonstrated sufficient professional ability to practice independently with the highest standard of competence. This final evaluation should be part of the fellow’s permanent record maintained by the institution.

Program director and teaching faculty The fellowship program director should be evaluated annually by the director of the general surgery core program or the chief of surgery at the primary hospital with respect to teaching effectiveness, scholarly research productivity, patient care activities, and administrative ability. On completion of the fellowship, fellows should submit a formal evaluation of the teaching faculty to be kept on file and made available to site reviewers.

Program The educational effectiveness of a fellowship program must be evaluated in a systematic manner. In particular, the quality of the curriculum and the extent to which fellows have met its educational goals must be assessed regularly by the program director and either the general surgery program director, the surgery department chair, or the chief of surgery at the fellowship’s primary hospital. In addition, fellows should be provided the opportunity to evaluate the fellowship on a regular basis, offer constructive feedback, identify deficiencies, and address problems or potential problems without fear of retribution. These evaluations should be circulated to the faculty, discussed with site reviewers, and submitted with other documentation during the accreditation and reaccreditation process. Written evaluations should be kept on file for 10 years. The Fellowship Council Membership Committee conducts a mandatory confidential exit survey at the conclusion of the fellow’s year. Program directors should forward this information to their fellows and follow up on its completion.

III. ACCREDITATION OF FELLOWSHIP COUNCIL FELLOWSHIPS

A. Curriculum Review and Approval Process

A surgery department wishing to have a Fellowship Council accredited fellowship must submit the following documents and should review the Accreditation Guidelines and Definitions criteria on the Accreditation website (see Appendix B).

Data Information Form

Curriculum vitae of program director and all key faculty members.

Curriculum vitae of current fellow (if applicable)

Case Logs -Previous Fellow(s) from the last 3 years (if applicable) summarized by case category and surgeon role (Primary, First Assistant, or Teaching Assistant)

Summary ACGME Defined Category Data for Graduating Chief Residents in the surgery training program affiliated with the fellowship for the last 3 years

Completed accreditation applications will be reviewed by the Accreditation Committee with representation from the constituent societies. An initial site visit will be conducted no sooner than 6 months into the first fellow’s year and if all components outlined in this document are verified, and there has been a review of the case logs and interviews with the current fellow(s), full accreditation (maximum of three years) will be conferred if performance is satisfactory. If not, the program will be fully accredited for less than three years and will need to be re-reviewed as indicated. A fellow must be in place in the program at the time of the Accreditation review.

Programs which fail to respond to citations and deficiencies identified by the Accreditation Committee, or which have two consecutive adverse reviews, risk withdrawal of accreditation. A majority vote of the Accreditation Committee as well as the Board of Directors will be required for full approval of a program. The Accreditation Committee will consider programs at any time as long as a fellow has been in place for at least 6 months. If the program is site visited but given a status of Not Accredited or Suspended, the program will not be able to participate in the matching process until otherwise advised by the Fellowship Council Board.

Program directors may submit a written appeal of the assigned status within 30 days. A subcommittee of the Accreditation Committee and the Board will consider the appeal and, if its findings warrant, recommend revoking the non-accredited or suspended status. Once any appeals for the decision for not accredited or suspended have been reviewed and ruled upon such that the status is confirmed, the Fellowship Council office will notify fellows currently in the program of its status. At the same time, the program will be identified in all registries as being not accredited or suspended. Once a plan is received to address the deficiencies in the program by the program director, the fellows will be given a copy of the program’s correction plan. Plans for correction of the program’s deficiencies must be received by the Fellowship Council office within 180 days of the decision. There will be a review of any program which was designated as not accredited or suspended. The review will occur the year following the notice unless there are extenuating circumstances for which the Accreditation Committee and Board will make a decision on the appropriate timeframe. If, at that review, the committee finds that a program is still deficient, membership approval for the program will be withdrawn and the program will be deleted from all registries.

The accreditation documentation for program approval must be received by the recommended deadline. Copies of the documentation may be distributed to committee members for review.

An accreditation fee is required for the accreditation committee to consider approval of the program. Approved programs will be charged an amount approved by the Board to cover costs of monitoring their programs and communication with other constituencies, such as the ABS and the RRC.

B. Site Visits

Site visits will be the mechanism for ensuring that fellowship programs meet the highest possible standards of quality. Site visits are required for the initial accreditation cycle. Site visitors will be appointed by the Accreditation Committee and will serve under their guidelines. Recommendations regarding accreditation are made to the Fellowship Council Board of Directors and the Board grants final approval. As part of the initial application process, the site visitor will perform a comprehensive review of the program and provide constructive feedback to the program director to ensure full compliance with fellowship guidelines. After this initial visit, site visits may occur at the request of a program director for the purpose of mediation, to provide administrative recommendations concerning the relationship between the fellowship program and the parent institution, or to help in other ways to ensure the continuity and quality of the fellowship program. Requests for site visits should be addressed to the Membership and Accreditation Committees, with the reasons for the request and the time frame in which such a visit is desired specified. The cost of a site visit will be borne by the requesting institution. Site visits may also be requested by the Accreditation Committee for programs that are in questionable compliance with fellowship guidelines. The following outlines some potential triggers for a site visit: a change in Program Director, a significant change in the associate faculty, insufficient case logs, program complaints, failure to address previous citations and conflicts with the residency program. In all cases, site visitors must present a report to the Chair of the Accreditation Committee no later than three weeks after the site visit.

C. Re-accreditation

Every three years or sooner, the Accreditation Committee will review the annual reports submitted by the director of the fellowship program. The program must review the Accreditation Guidelines and Definitions criteria on the Re-Accreditation website. The report must include all of the documents listed in Section A plus the following (see Appendix B):

Reaccreditation Data Information Form

Current Fellow Survey (confidential online survey)

Past Fellows Survey (confidential online survey)

General Surgery Program Director Survey (confidential online survey), if applicable.

Summary of defined category General Surgery chief resident experience from the institution, if applicable.

Surveys from the Program Director(s) of any other related ACGME accredited/ABMS- or Royal College of Physicians & Surgeons of Canada- recognized surgical training program(s), if applicable.

Re-accreditation of the program will be based on the committee’s findings during the review. Programs that do not meet the requirements described in this document may be site visited, accredited with citation, or not accredited or suspended. The following outlines some potential triggers for a site visit: a change in Program Director, a significant change in the associate faculty, insufficient case logs, program complaints, failure to address previous citations and conflicts with the residency program. A letter detailing the committee’s reasons for assigning not accredited or suspended status to a program will be sent to the program director. A similar letter will be sent to directors of programs accredited with citations. Program directors may submit a written appeal of the assigned status within 30 days. A subcommittee of the Board and the Accreditation Committee will consider the appeal and, if its findings warrant, recommend revoking the not accredited or suspended status. Once any appeals for the decision for not accredited or suspended have been reviewed and ruled upon such appeals that status is confirmed, the program and the Fellowship Council office will notify fellows currently in the program of its status. At the same time, the program will be identified in all registries as being not accredited or suspended. Once a plan is received to address the deficiencies in the program by the program director, the fellows will be given a copy of the program’s correction plan. Plans for correction of the program’s deficiencies must be received by the Fellowship Council office within 180 days. There will be a review of any program which was designated as not accredited or suspended. The review will occur the year following the notice unless there are extenuating circumstances for which the Accreditation Committee and Board will make a decision on the appropriate timeframe. If, at that review, the committee finds that a program is still deficient, approval for the program will be withdrawn and the program will be deleted from all registries. For programs given accreditation with citations, submission of such a plan is not required; however, failure to correct the cited deficiencies by the time of a subsequent review may result in probation, not accredited or suspended status.

IV. PROPOSED ACTIVITIES OF THE CONSTITUENT SOCIETIES IN RELATION TO THE FELLOWSHIP COUNCIL

The member societies will nominate members to the Accreditation Committee and encourage participation of fellows at their annual meetings.

A. Accreditation of Fellowships

The constituent societies will nominate members to the Accreditation Committee, whose purpose will be to review all applications for accreditation of fellowship programs, make recommendation of approval of fellowship programs to the board, and monitor evolution of the fellowship programs in general. The intent is to establish a process similar to that currently carried out by the RRC for general surgery.

B. Annual Meeting of Program Directors and Fellows

The Fellowship Council will sponsor an annual meeting of program directors of member programs. The purpose of this meeting will be to provide a forum for discussing program issues, recommending ways of promoting high-quality fellowship education, reviewing the matching process, advising the accreditation committee on grievance and approval issues, recommending creation of special programs or projects for advancing surgical education, and supplying members with program advice. The societies will be encouraged to offer fellows the opportunity to meet during their annual scientific meetings and to actively solicit research and clinical papers by fellows.

C. Fellowship Registry

The Membership Committee will act as a registry and clearinghouse for fellowship programs and prospective fellows. Efforts will be made to assist in the recruitment and placement of candidates for fellowship. Such efforts will include placing advertisements in appropriate journals, sponsoring program director and resident events at national meetings, and informing society members of fellowship opportunities by mail. The Fellowship Council will maintain a directory of approved fellowship programs. This directory will be made available to eligible applicants or residency program directors, and each society will provide a link to the directory on its web site. For each fellowship program, the directory will include the name of the program, program director, program coordinator, and primary institution; the focus and duration of the fellowship; and the salary range, when appropriate. The Fellowship Council will also maintain an updated and confidential file on each approved program that includes the original application form; a statement regarding the program’s approval status; letters of grievance; letters of recommendation; site visit reports; past fellows’ case logs; and documentation of the operative experience of the previous year’s fellows. The Membership Committee will also maintain a confidential record of non­compliance or problems. A copy of individual files, including a summary of grievances filed, will be made available to the fellowship program director on request.

D. Fellowship Matching Process

The Communications Committee has established a fair and equitable matching process similar to that used jointly by the AAMC, the ACGME, and the ABMS.

APPENDIX A

The medical device and pharmaceutical industries have long played an important role in the training of surgeons. Through different types of contributions these companies have enabled and encouraged the rapid growth of postgraduate training programs in the disciplines represented by the Fellowship Council. This in turn has contributed to the availability and quality of MIS and GI specialty surgery to the public. The Fellowship Council (FC) recognizes these substantial role that Industry play in the promulgation of fellowship programs. The primary tasks of the FC is to ensure the quality of fellowship training programs in order to assure applicants and the public that accredited programs meet a high standard of excellence in training. This accreditation process is a serious and critical one and must be performed in the most stringently ethical manner following the new ADVAMED guidelines 3 in order to maintain the trust and respect of all parties involved. Guidelines for ethical behavior have been developed by both physicians1 and industry2 -3 and the Fellowship Council has referenced these to create the following code of conduct to ensure proper ethical behavior between Industry, the FC and member FC programs:

The Fellowship Council

The FC recognizes the critical role that Industry has played in the advancement of postgraduate training programs and wishes to keep industry supporters and the public fully informed of processes and developments in fellowship programs. It is part of the mission of the FC to accredit programs and to represent the specialty societies represented by the FC to the governing bodies of surgery. As such, it is necessary that the FC holds itself to the highest ethical standards and avoids any conflicts of interest, perceived or actual. The following guidelines are therefore presented to ensure a superior working relationship between Industry and the FC while avoiding the appearance of impropriety:

Requests or acceptance of Industry contributions require a majority vote of the FC Board of Governors and can only be accepted if in compliance with the 2009 ADVAMED code of Ethics.

Individual members of the FC shall not solicit contributions from Industry on behalf of the FC.

Industry contributions should be accepted only if they are in compliance with ADVAMED guidelines

Industry supported events will be approved only if they are oriented towards education and research provided they are in compliance with ADVAMED guidelines

Industry supported events and projects must be clearly labeled as such.

An Industry representative may be invited to present a report to the Board of Governors or FC committees but shall have no vote and should not attend non-related portions of the meetings.

Member Programs

The Fellowship Council recognizes that in the past most fellowship programs belonging to the FC received financial or other support from Industry. Fellowship programs belonging to the FC will only receive contributions for their fellows training under strict compliance with ADVAMED Code of Ethics.

The Fellowship Council believes that such arrangements will eliminate conflict of interest, as well as prevent harm to the program involved, its constituents and the public. Member programs belonging to the FC should, therefore, adhere to the following guidelines in order to avoid the appearance of non-ethical behaviors.

Industry support of a FC program can only be granted in compliance with ADVAMED guidelines. The following guidelines must be enforced:

Industry support of a FC program shall not be contingent on or tied to purchasing agreements between the sponsoring institution and the sponsoring company.

Fellow education curricula and research efforts should be designed and administered by the fellowship program director.

Industry sponsorship and involvement in the program will occur via the Foundation for Surgical Fellowships, thereby assuring the appropriate avoidance of conflict of interest between Industry and the individual fellowship.

Efforts should be made to expose fellows to a broad spectrum of available devices and drugs beyond that of any sponsoring company.

Industry

Industry relevant offerings in research and training can only be made available to the FC and its member programs provided they follow ADVAMED guidelines. Many industry potential supporters of FC or member program efforts are already voluntarily following strict guidelines regarding their interactions and support of healthcare professionals 3. Specific to the FC the following guidelines should be followed:

Proposals for support from Industry to the FC should be made in writing to the President of the FC.

The FC will consider all such proposals for support in accord with the Advanced Medical Technology Association (AdvaMed) Code of Ethics

Creating a Bright Future for Fellowship TrainingOver its 21 year history, the Fellowship Council (FC) has evolved considerably and continues to serve a vital purpose of providing oversight to non-ACGME gastrointestinal and related surgical fellowships. The FC maintains a robust infrastructure, including an accreditation process with site visits, a matching process, a caselog database, and an evaluation system. The FC offers fellowships in Advanced GI, Advanced GI/MIS, Bariatric, … [Read More...]